Two faces of abortion

September 1, 2016, 9:19 pm

Continued from last week

Last week we saw how contentious the issue of (induced) abortion is in our country. Well, this is the case to be expected in many countries around the world. As much as the health professionals and activists are willing to see that their proposal to amend the present abortion law will go through the parliament, the religious organisations will not give an inch to upset the apple cart with regard to the present status of abortion law in the country.

Last week, His Lordship Bishop Dr. Emmanuel Fernando of the Catholic Church, in no uncertain terms, remarked that the position of the Catholic Church regarding abortion in fact is even a step ahead of the present Sri Lankan law, and in no circumstance humans have right to end life of another human being, whether it be inside the womb of the mother or outside. Even Ven. Dr. Dambara Amila Thero, senior lecturer in archeology, University of Sri Jayawardenapura held a similar view regarding the subject.

The sentiments of all the main religious institutions in the country, Buddhist, Christian, Hindu and Islam, with regard to abortion will be more or less the same - a common "NO". Likely that both sides of the divide, scientific and social vis-à-vis religious and moralist, won’t back down one inch from their original standpoint, as it is a point of no return.

In 1995, under Chandrika Kumaratunge’s presidency, when this matter was debated in the parliament the moralist viewpoint squashed the scientific community and activists pants down. So, it would be interesting to see what the strategies of those who propose amendments to the abortion law and how they would position themselves this time, to avoid a frustrating defeat like in the last time. However, as per the news reaching us, still they are without a committed trendsetter to take the lead role in presenting the proposals to the parliament. Is this for the lack of commitment to the cause or for thorniness surrounding it or for some other reason is unknown.

Laws on Abortion– Global scenario

Laws on abortion either expressly allow abortion to be performed only to save the life of a woman or are governed by general principles of criminal legislation which allow abortion to be performed for that reason on the ground of necessity. In addition, the British case of R. v Bourne or local application of that decision apply. Under that decision, the ground of necessity was interpreted to encompass abortion performed on grounds of preserving physical and mental health.

Definitions and Sources:

Grounds on which abortion is permitted indicate legal provisions under which the Government permits induced abortion in the country.

Seven grounds on which abortion is permitted are distinguished:

(1) to save the life of a woman;

(2) to preserve a woman’s physical health;

(3) to preserve a woman’s mental health;

(4) in case of rape or incest;

(5) because of foetal impairment;

(6) for economic or social reasons and (7) on request. (Source: United Nations, Department of Economic and Social Affairs, Population Division, World Population Policies 2011 - United Nations publication, Sales No. E.13.XIII.2)

Unsafe abortions - According to the World Health Organization, unsafe abortion is a procedure for terminating an unwanted pregnancy carried out by persons who may lack the necessary skills or conducted in an environment lacking minimal medical standards or both. An unsafe abortion may be performed by the pregnant woman herself, by a person lacking medical training or by a health worker in unhygienic conditions or using unsafe methods. (Source: Iqbal Shah and Elisabeth Åhman. 2010. Unsafe Abortion in 2008: Global and Regional Levels and Trends. Reproductive Health Matters, vol. 18, No. 36, pp. 90–101)

The above table categorizes countries around the world as "least restrictive countries" (i.e. - the countries that allow abortions for economic and social reasons or on request) and "most restrictive countries" (i.e. - countries that do not permit abortion on any ground or permit abortion only to save a woman’s life) according to the abortion laws they practice. (The third category according to this classification is "less restrictive countries").

South Asian comparison

Sri Lanka belongs to the "most restrictive" category, stands out as a rare exception being a middle income country (whereas majority of those countries belonging to this category are low income ones). Just eyeballing the table one could easily grasp that most of the countries that fall into the "least restrictive" group are the developed Western countries which anyway have liberal laws related to sexual and reproductive matters, and into the "most restrictive" basket are the less developed countries of the global south, which anyway are restricted by religious and cultural values regarding these matters. While the abortion rates are known for most of the "least restrictive" countries, the same is unknown or obscure in most of the "most restrictive" countries, for they are illegal in those countries.

While Afghanistan and Bangladesh are the only other South Asian companions of Sri Lanka in the "most restrictive" category, even countries like India, Bhutan (predominantly a Buddhist country), Pakistan and Maldives (both Muslim countries) have lesser restrictive legal positions regarding abortion than Sri Lanka. In this regard, Nepal, a predominantly Hindu and comparatively lesser developed country, has strangely gone the whole hog by liberalizing the abortion law to the hilt, comparable to a developed Western country. On the other hand, for Nepal with a population growth rate of over 2% till almost turn of this century and Maternal Mortality Ratio (MMR) of 900 in 1990 (one of the highest then), need of drastic measures to control population while providing safe maternal and reproductive care had been imperative.

As a region MMR in South Asia has dropped from 558 to 182 (between 1990 and 2015), while in the world, the overall drop during the same quarter of century has been less striking being from 385 to 216. During this period, many countries that hitherto held more restrictive positions regarding abortion "liberalized" their abortion laws with the auspices of international donor agencies in the wake of rapid thrust toward realization of Millennium Development Goals (MDGs).

Nepal’s success story

Between 1990 and 2006, Nepal brought down its MMR by more than 2/3, from 900 deaths per 100,000 live births, to 281, according to the Demographic and Health Survey (DHS). (A 2012 UNFPA report estimated Nepal’s MMR 2010 to be at 170). Observed declines since the early 1990s make Nepal, together with Bangladesh, the most recent "success story", comparable to countries like Malaysia, Thailand and Cuba that gained ground decades earlier (IRIN).

In Nepal, women now give birth on average to 2.6 children versus 4.6 children 15 years ago.

Experiences elsewhere – comparative statistics between 1990 and 2015

Like Nepal, number of other countries that adopted liberal abortion laws (together with improved maternal and reproductive services) have recorded drastic decline in maternal deaths. These include Cambodia (from 1,020 in 1990 to 160 in 2015), Equatorial Guinea (from 1,310 to 342 during the same period), Eretria (from 1,590 to 500), Ethiopia (from 1,250 to 350), India (from 556 to 174), Laos (from 905 to 197), Mozambique (from 1,390 to 489) and Rwanda (from 1,300 to 290). On the other hand, some previously high maternal mortality burdened countries have reduced their maternal deaths appreciably by merely improving maternal and reproductive services, without resorting to liberal abortion laws. These countries include Afghanistan (from 1,340 to 396), Angola (from 1,160 to 477), Bangladesh (from 569 to 176), Bhutan (from 945 to 148), Brazil (from 104 to 44) and Timor-Leste (from 1,080 to 215).

Chile, being a "most restrictive" country that does not permit abortion on any ground, while having one of the lowest abortion rates (less than 0.5), has performed remarkably well with regard to the MMR as well, by reducing it from anyway low 57, further to 22). Likewise, Dominican Republic in the Caribbean, again a "most restrictive" country with no permission to abortion on any ground, has more than halved the MMR from 198 to 92, during the period under study.

Sri Lanka too has more than halved her MMR from 75 to 30, between 1990 and 2015, being a "most restrictive" country with allowance for abortion only to save a woman’s life. Interestingly, Abortion Rate for Sri Lanka still remains unknown according to the quoted UN Population Division statistics, despite a UNFPA funded large scale study on induced abortions in the past.